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In their third edition, Robbie Adler-Tapia, PhD and Carolyn Settle, MSW, LCSW have surpassed the high standards they set with the two previous editions of their Guidebook and Treatment Manual. This wonderfully accessible book is essential reading for all EMDR therapists who treat children. You can order this book from the Springer Publishing Company or from Amazon as a large format softcover book that comes with e-book access.

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The video of the month is a free 90-minute webinar from Mary-Anne Kate on using the MID-60 to identify dissociation.

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Al Jowf, G. I., Ahmed, Z. T., Reijnders, R. A., de Nijs, L., & Eijssen, L. M. T. (2023). To Predict, Prevent, and Manage Post-Traumatic Stress Disorder (PTSD): A Review of Pathophysiology, Treatment, and Biomarkers. Int J Mol Sci, 24(6), 5238. https://doi.org/10.3390/ijms24065238

Open Access: https://doi.org/10.3390/ijms24065238

Ghazi I. Al Jowf and Lars M. T. Eijssen, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands. E-mail: ghazi.aljowf@maastrichtuniversity.nl E-mail: l.eijssen@maastrichtuniversity.nl

Abstract

Post-traumatic stress disorder (PTSD) can become a chronic and severely disabling condition resulting in a reduced quality of life and increased economic burden. The disorder is directly related to exposure to a traumatic event, e.g., a real or threatened injury, death, or sexual assault. Extensive research has been done on the neurobiological alterations underlying the disorder and its related phenotypes, revealing brain circuit disruption, neurotransmitter dysregulation, and hypothalamic-pituitary-adrenal (HPA) axis dysfunction. Psychotherapy remains the first-line treatment option for PTSD given its good efficacy, although pharmacotherapy can also be used as a stand-alone or in combination with psychotherapy. In order to reduce the prevalence and burden of the disorder, multilevel models of prevention have been developed to detect the disorder as early as possible and to reduce morbidity in those with established diseases. Despite the clinical grounds of diagnosis, attention is increasing to the discovery of reliable biomarkers that can predict susceptibility, aid diagnosis, or monitor treatment. Several potential biomarkers have been linked with pathophysiological changes related to PTSD, encouraging further research to identify actionable targets. This review highlights the current literature regarding the pathophysiology, disease development models, treatment modalities, and preventive models from a public health perspective, and discusses the current state of biomarker research.

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Alpert, E., Shotwell Tabke, C., Cole, T. A., Lee, D. J., & Sloan, D. M. (2023). A systematic review of literature examining mediators and mechanisms of change in empirically supported treatments for posttraumatic stress disorder. Clin Psychol Rev, 103, 102300. https://doi.org/10.1016/j.cpr.2023.102300

URL: https://pubmed.ncbi.nlm.nih.gov/37320986

Elizabeth Alpert, VA Boston Healthcare System, 150 S. Huntington Ave. (116B-3), Boston, MA 02130, United States of America. E-mail address: Elizabeth.Alpert@va.gov

Abstract

Despite the availability of empirically supported treatments (ESTs) for posttraumatic stress disorder (PTSD), relatively little is known regarding these treatments' mechanisms of change. This systematic review moves beyond previous reviews by summarizing the findings and reviewing the methodological quality of literature that specifically examined mediators/mechanisms of change in ESTs for PTSD. Studies were included if they were written in English, empirical, peer-reviewed, claimed to study mediators/mechanisms of a recommended PTSD treatment, measured the mediator/mechanism during or before and after treatment, and included a posttreatment PTSD or global outcome (e.g., functioning). PsycINFO and PubMed were searched on October 7, 2022. Two coders screened and coded studies. Sixty-two eligible studies were identified. The most consistent mediator/mechanism was reduction in negative posttraumatic cognitions, followed by between-session extinction and decreased depression. Only 47% of studies measured the mediator/mechanism before the outcome and measured the mediator/mechanism and outcome at least three times, and 32% also used growth curve modeling to establish temporal precedence of change in the mediator/mechanism and outcome. Many of the mediators/mechanisms examined had weak or no empirical support. Results highlight the need for improved methodological rigor in treatment mediator and mechanism research. Implications for clinical care and research are discussed. PROSPERO ID: 248088.

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Anderson, D., & Jones, V. (2023). Psychological interventions for cancer-related post-traumatic stress disorder: narrative review. BJPsych Bull, 1-10. https://doi.org/10.1192/bjb.2023.42

Open Access: https://pubmed.ncbi.nlm.nih.gov/37288666

Dr Daniel Anderson, The Christie NHS Foundation Trust, Manchester, UK. Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK. E-mail: daniel.anderson16@nhs.net

Abstract

AIMS AND METHOD: This narrative review updates the evidence base for cancer-related post-traumatic stress disorder (PTSD). Databases were searched in December 2021, and included EMBASE, Medline, PsycINFO and PubMed. Adults diagnosed with cancer who had symptoms of PTSD were included.
RESULTS: The initial search identified 182 records, and 11 studies were included in the final review. Psychological interventions were varied, and cognitive-behavioural therapy and eye movement desensitisation and reprocessing were perceived to be most efficacious. The studies were also independently rated for methodological quality, which was found to be hugely variable.
CLINICAL IMPLICATIONS: There remains a lack of high-quality intervention studies for PTSD in cancer, and there is a wide range of approaches to managing these conditions, with a large heterogeneity in the cancer populations examined and methodologies used. Specific studies designed with patient and public engagement and that tailor the PTSD intervention to particular cancer populations under investigation are required.

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Beiner, E., Baumeister, D., Buhai, D., Löffler, M., Löffler, A., Schick, A., Ader, L., Eich, W., Sirazitdinov, A., Malone, C., Hopp, M., Ruckes, C., Hesser, J., Reininghaus, U., Flor, H., Tesarz, J., & PerPAIN, C. (2022). The PerPAIN trial: a pilot randomized controlled trial of personalized treatment allocation for chronic musculoskeletal pain-a protocol. Pilot Feasibility Stud, 8(1), 251. https://doi.org/10.1186/s40814-022-01199-6

Open Access: https://pubmed.ncbi.nlm.nih.gov/36494768

Jonas Tesarz, Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany. E-mail: jonas.tesarz@med.uni-heidelberg.de

Abstract

BACKGROUND: The therapy of chronic musculoskeletal pain (CMSP) is complex and the treatment results are often insufficient despite numerous therapeutic options. While individual patients respond very well to specific interventions, other patients show no improvement. Personalized treatment assignment offers a promising approach to improve response rates; however, there are no validated cross-disease allocation algorithms available for the treatment of chronic pain in validated personalized pain interventions. This trial aims to test the feasibility and safety of a personalized pain psychotherapy allocation with three different treatment modules and estimate initial signals of efficacy and utility of such an approach compared to non-personalized allocation.
METHODS: This is a randomized, controlled assessor-blinded pilot trial with a multifactorial parallel arm design. CMSP patients (n = 105) will be randomly assigned 1:1 to personalized or non-personalized treatment based on a cluster assignment of the West Haven-Yale Multidimensional Pain Inventory (MPI). In the personalized assignment condition, patients with high levels of distress receive an emotional distress-tailored intervention, patients with pain-related interference receive an exposure/extinction-tailored treatment intervention and patients who adapt relatively well to the pain receive a low-level smartphone-based activity diary intervention. In the control arm, patients receive one of the two non-matching interventions. Effect sizes will be calculated for change in core pain outcome domains (pain intensity, physical and emotional functioning, stress experience, participant ratings of improvement and satisfaction) after intervention and at follow-up. Feasibility and safety outcomes will assess rates of recruitment, retention, adherence and adverse events. Additional data on neurobiological and psychological characteristics of the patients are collected to improve treatment allocation in future studies.
CONCLUSION: Although the call for personalized treatment approaches is widely discussed, randomized controlled trials are lacking. As the personalization of treatment approaches is challenging, both allocation and intervention need to be dynamically coordinated. This study will test the feasibility and safety of a novel study design in order to provide a methodological framework for future multicentre RCTs for personalized pain psychotherapy.
TRIAL REGISTRATION: German Clinical Trials Register, DRKS00022792 ( https://www.drks.de ). Prospectively registered on 04/06/2021.

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Belvedere, C., Fabbrini, P., Alberghini, E., Ghedini, S. A., Fernandez, I., Maslovaric, G., Pagani, M., & Gallina, E. (2023). Intervention with EMDR on a sample of healthcare workers in the nephrology and dialysis service during the COVID-19 emergency: from immediate treatment effect to long-term maintenance. Front Psychol, 14, 1120203. https://doi.org/10.3389/fpsyg.2023.1120203

Open Access: https://pubmed.ncbi.nlm.nih.gov/37228335

Caterina Belvedere, ASST Nord Milano, Milan, Italy. E-mail: catebelvedere@gmail.com

Abstract

BACKGROUND: During the COVID-19 pandemic, psychological support was provided to healthcare workers in Nephrology and Dialysis Operative Unit of the Azienda Ospedaliera Bassini using an EMDR group protocol to decrease posttraumatic stress symptoms in the medium and long term. The aim of this study was to demonstrate the effectiveness of EMDR treatment to reduce post-traumatic stress symptoms at the end of the first pandemic wave and its progress over time in the subsequent phases of the health emergency.
METHODS: The sample of study consisted of 43 healthcare workers from the Nephrology and Dialysis Service who spontaneously decided to take part in the Brief EMDR treatment. Statistical analyses were carried out to compare the data collected with the IES-R, the Emotion Thermometer and the Post-Traumatic Growth Scale. The comparisons covered pre-treatment, post-treatment and follow-up.
RESULTS: The results show a significant clinical improvement in reducing PTSD symptoms following the Brief EMDR group treatment. The comparison between PRE and POST treatment (DELTA1) regarding the scores from IES-R and Emotion Thermometer, highlighted the important statistically change that occurred in terms of symptomatology reduction (p < 0.001). By comparing POST and FU (DELTA2), it was observed that all variables except avoidance show a significant weakening of the effect with time (p < 0.001), but the magnitude of this effect is much smaller than the improvement found in DELTA1. DELTA 3 analysis finally made it possible to highlight how the treatment effect is maintained almost intact at follow-up. In fact, the maintenance of a better situation at follow-up was observed, in the course of re-traumatization linked to the new wave, compared to the initial data (p < 0.001).
CONCLUSION: The COVID-19 health emergency has significantly impacted hospital healthcare workers, leading to a high risk of developing PTSD symptoms. A psychological intervention aimed at the operators themselves is therefore of great importance.

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Brewerton, T. D. (2023). The integrated treatment of eating disorders, posttraumatic stress disorder, and psychiatric comorbidity: a commentary on the evolution of principles and guidelines. Front Psychiatry, 14, 1149433. https://doi.org/10.3389/fpsyt.2023.1149433

Open Access: https://pubmed.ncbi.nlm.nih.gov/37252137

Timothy D. Brewerton, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States. E-mail: drtimothybrewerton@gmail.com

Abstract

Psychiatric comorbidity is the norm in the assessment and treatment of eating disorders (EDs), and traumatic events and lifetime PTSD are often major drivers of these challenging complexities. Given that trauma, PTSD, and psychiatric comorbidity significantly influence ED outcomes, it is imperative that these problems be appropriately addressed in ED practice guidelines. The presence of associated psychiatric comorbidity is noted in some but not all sets of existing guidelines, but they mostly do little to address the problem other than referring to independent guidelines for other disorders. This disconnect perpetuates a in which each set of guidelines do not address the complexity of the other comorbidities. Although there are several published practice guidelines for the treatment of EDs, and likewise, there are several published practice guidelines for the treatment of PTSD, none of them specifically address ED + PTSD. The result is a lack of integration between ED and PTSD treatment providers, which often leads to fragmented, incomplete, uncoordinated and ineffective care of severely ill patients with ED + PTSD. This situation can inadvertently promote chronicity and multimorbidity and may be particularly relevant for patients treated in higher levels of care, where prevalence rates of concurrent PTSD reach as high as 50% with many more having subthreshold PTSD. Although there has been some progress in the recognition and treatment of ED + PTSD, recommendations for treating this common comorbidity remain undeveloped, particularly when there are other co-occurring psychiatric disorders, such as mood, anxiety, dissociative, substance use, impulse control, obsessive-compulsive, attention-deficit hyperactivity, and personality disorders, all of which may also be trauma-related. In this commentary, guidelines for assessing and treating patients with ED + PTSD and related comorbidity are critically reviewed. An integrated set of principles used in treatment planning of PTSD and trauma-related disorders is recommended in the context of intensive ED therapy. These principles and strategies are borrowed from several relevant evidence-based approaches. Evidence suggests that continuing with traditional single-disorder focused, sequential treatment models that do not prioritize integrated, trauma-focused treatment approaches are short-sighted and often inadvertently perpetuate this dangerous multimorbidity. Future ED practice guidelines would do well to address concurrent illness in more depth.

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Burback, L., Brémault-Phillips, S., Nijdam, M. J., McFarlane, A., & Vermetten, E. (2023). Treatment of Posttraumatic Stress Disorder: a State-of-the-art Review. Curr Neuropharmacol. https://doi.org/10.2174/1570159X21666230428091433

Open Access: https://pubmed.ncbi.nlm.nih.gov/37132142

Lisa Burback, Department of Psychiatry, University of Alberta, Alberta, Canada. E-mail: burback@ualberta.ca

Abstract

This narrative state-of-the-art review paper describes the progress in the understanding and treatment of Posttraumatic Stress Disorder (PTSD). Over the last four decades, the scientific landscape has matured, with many interdisciplinary contributions to understanding its diagnosis, etiology, and epidemiology. Advances in genetics, neurobiology, stress pathophysiology, and brain imaging have made it apparent that chronic PTSD is a systemic disorder with high allostatic load. The current state of treatment yields a wide variety of pharmacological and psychotherapeutic approaches, of which many are evidence-based. However, the myriad challenges inherent in the disorder, such as individual and systemic barriers to treatment outcome, comorbidity, emotional dysregulation, suicidality, dissociation, substance use, and trauma-related guilt and shame often render treatment response suboptimal. These challenges are discussed as drivers for emerging novel treatment approaches, including early interventions in the Golden Hours, pharmacological and psychotherapeutic interventions, medication augmentation interventions, the use of psychedelics, as well as interventions targeting the brain and nervous system. All of this aims to improve symptom relief and clinical outcomes. Finally, a phase orientation to treatment is recognized as a tool to strategize treatment of the disorder, and position interventions in step with the progression of the pathophysiology. Revisions to guidelines and systems of care will be needed to incorporate innovative treatments as evidence emerges and they become mainstream. This generation is well-positioned to address the devastating and often chronic disabling impact of traumatic stress events through holistic, cutting-edge clinical efforts and interdisciplinary research.

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Burkhart, K., Agarwal, N., Kim, S., Neudecker, M., & Ievers-Landis, C. E. (2023). A Scoping Review of Trauma-Informed Pediatric Interventions in Response to Natural and Biologic Disasters. Children (Basel), 10(6), 1017. https://doi.org/10.3390/children10061017

Open Access: https://pubmed.ncbi.nlm.nih.gov/37371249

Kimberly Burkhart, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, 10524 Euclid Ave., Cleveland, OH 44106, USA. E-mail: kimberly.burkhart@uhhospitals.org

Abstract

A scoping review was performed of trauma-informed psychological interventions to treat anxiety, depression, and posttraumatic stress symptoms in youth in response to natural/biologic disasters. The specific aims were to identify psychosocial interventions used in response to natural/biologic disasters, report the interventions' effectiveness, describe limitations, and provide treatment recommendations and future directions. Of the 45 studies extracted, 28 were on natural disasters and 17 on biologic disasters with the majority related to the COVID-19 pandemic. The most commonly implemented interventions were Cognitive Behavioral Therapy (CBT), Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), and eye movement desensitization and reprocessing (EMDR). The UCLA Posttraumatic Stress Disorder Reaction Index (UCLA PTSD-RI) and the Strengths and Difficulties Questionnaire (SDQ) were the most frequently used measures. Methodological rigor was varied, with 60% randomized, controlled trials. Overall, there was a significant decrease in posttraumatic stress symptoms, distress, anxiety, and depression regardless of whether the participant received CBT, TF-CBT, or EMDR. Generally, there was not a significant decrease in anxiety and depression with yoga, cognitive fear-reduction, emotion-based drawing, and community health education. Recommendations for future directions include larger-scale studies with group and on-line interventions that include younger children with moderation analyses by gender and race/ethnicity.

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Caro, P., Turner, W., Caldwell, D. M., & Macdonald, G. (2023). Comparative effectiveness of psychological interventions for treating the psychological consequences of sexual abuse in children and adolescents: a network meta-analysis. Cochrane Database Syst Rev, 6(6), CD013361. https://doi.org/10.1002/14651858.CD013361.pub2

Open Access: https://pubmed.ncbi.nlm.nih.gov/37279309

Paola Caro, School for Policy Studies, University of Bristol, Bristol, UK. E-mail: jc16113@bristol.ac.uk.

Abstract

BACKGROUND: Following sexual abuse, children and young people may develop a range of psychological problems, including anxiety, depression, post-traumatic stress disorder (PTSD), and a range of behaviour problems. Those working with children and young people experiencing these problems may use one or more of a range of psychological approaches.
OBJECTIVES: To assess the relative effectiveness of psychological interventions compared to other treatments or no treatment controls, to overcome psychological consequences of sexual abuse in children and young people up to 18 years of age. Secondary objectives To rank psychotherapies according to their effectiveness. To compare different 'doses' of the same intervention.
SEARCH METHODS: In November 2022 we searched CENTRAL, MEDLINE, Embase, PsycINFO, 12 other databases and two trials registers. We reviewed the reference lists of included studies, alongside other work in the field, and communicated with the authors of included studies.
SELECTION CRITERIA: We included randomised controlled trials comparing psychological interventions for sexually abused children and young people up to 18 years old with other treatments or no treatments. Interventions included: cognitive behavioural therapy (CBT), psychodynamic therapy, family therapy, child centred therapy (CCT), and eye movement desensitisation and reprocessing (EMDR). We included both individual and group formats.
DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, extracted data and assessed the risk of bias for our primary outcomes (psychological distress/mental health, behaviour, social functioning, relationships with family and others) and secondary outcomes (substance misuse, delinquency, resilience, carer distress and efficacy). We considered the effects of the interventions on all outcomes at post-treatment, six months follow-up and 12 months follow-up. For each outcome and time point with sufficient data, we performed random-effects network and pairwise meta-analyses to determine an overall effect estimate for each possible pair of therapies. Where meta-analysis was not possible, we report the summaries from single studies. Due to the low number of studies in each network, we did not attempt to determine the probabilities of each treatment being the most effective relative to the others for each outcome at each time point. We rated the certainty of evidence with GRADE for each outcome.
MAIN RESULTS: We included 22 studies (1478 participants) in this review. Most of the participants were female (range: 52% to 100%), and were mainly white. Limited information was provided on socioeconomic status of participants. Seventeen studies were conducted in North America, with the remaining studies conducted in the UK (N = 2), Iran (N = 1), Australia (N = 1) and Democratic Republic of Congo (N = 1). CBT was explored in 14 studies and CCT in eight studies; psychodynamic therapy, family therapy and EMDR were each explored in two studies. Management as usual (MAU) was the comparator in three studies and a waiting list was the comparator in five studies. For all outcomes, comparisons were informed by low numbers of studies (one to three per comparison), sample sizes were small (median = 52, range 11 to 229) and networks were poorly connected. Our estimates were all imprecise and uncertain. Primary outcomes At post-treatment, network meta-analysis (NMA) was possible for measures of psychological distress and behaviour, but not for social functioning. Relative to MAU, there was very low certainty evidence that CCT involving parent and child reduced PTSD (standardised mean difference (SMD) -0.87, 95% confidence intervals (CI) -1.64 to -0.10), and CBT with only the child reduced PTSD symptoms (SMD -0.96, 95% CI -1.72 to -0.20). There was no clear evidence of an effect of any therapy relative to MAU for other primary outcomes or at any other time point. Secondary outcomes Compared to MAU, there was very low certainty evidence that, at post-treatment, CBT delivered to the child and the carer might reduce parents' emotional reactions (SMD -6.95, 95% CI -10.11 to -3.80), and that CCT might reduce parents' stress. However, there is high uncertainty in these effect estimates and both comparisons were informed only by one study. There was no evidence that the other therapies improved any other secondary outcome. We attributed very low levels of confidence for all NMA and pairwise estimates for the following reasons. Reporting limitations resulted in judgements of 'unclear' to 'high' risk of bias in relation to selection, detection, performance, attrition and reporting bias; the effect estimates we derived were imprecise, and small or close to no change; our networks were underpowered due to the low number of studies informing them; and whilst studies were broadly comparable with regard to settings, the use of a manual, the training of the therapists, the duration of treatment and number of sessions offered, there was considerable variability in the age of participants and the format in which the interventions were delivered (individual or group).
AUTHORS' CONCLUSIONS: There was weak evidence that both CCT (delivered to child and carer) and CBT (delivered to the child) might reduce PTSD symptoms at post-treatment. However, the effect estimates are uncertain and imprecise. For the remaining outcomes examined, none of the estimates suggested that any of the interventions reduced symptoms compared to management as usual. Weaknesses in the evidence base include the dearth of evidence from low- and middle-income countries. Further, not all interventions have been evaluated to the same extent, and there is little evidence regarding the effectiveness of interventions for male participants or those from different ethnicities. In 18 studies, the age ranges of participants ranged from 4 to 16 years old or 5 to 17 years old. This may have influenced the way in which the interventions were delivered, received, and consequently influenced outcomes. Many of the included studies evaluated interventions that were developed by members of the research team. In others, developers were involved in monitoring the delivery of the treatment. It remains the case that evaluations conducted by independent research teams are needed to reduce the potential for investigator bias. Studies addressing these gaps would help to establish the relative effectiveness of interventions currently used with this vulnerable population.

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Cope, S. R., Smith, J. G., El-Leithy, S., Vanzan, S., Pentland, C., Pick, S., Golder, D., Hogwood, P., Turner, K., Billings, J., & Edwards, M. J. (2023). MODIFI: protocol for randomised feasibility study of eye-movement desensitisation and reprocessing therapy (EMDR) for functional neurological disorder (FND). BMJ Open, 13(6), e073727. https://doi.org/10.1136/bmjopen-2023-073727

Open Access: https://pubmed.ncbi.nlm.nih.gov/37270188

Sarah R Cope, South West London and St George’s Mental Health NHS Trust, Tooting, UK. E-mail: sarah.cope@swlstg.nhs.uk

Abstract

INTRODUCTION: Functional neurological disorder (FND) refers to an involuntary loss of control over and/or aberrant perception of the body. Common presenting symptoms are functional (non-epileptic) seizures, and functional motor disorder, for example, walking difficulties, weakness or tremor. Greater access to effective treatments would lead to reduced distress and disability; and reduce unnecessary healthcare costs. This study will examine eye-movement desensitisation and reprocessing therapy (EMDR) as a treatment for FND. EMDR is an evidence-based treatment for post-traumatic stress disorder (PTSD), but its use for other conditions is growing. An FND-specific EMDR protocol will be tested, and if the intervention proves feasible with promising clinical outcomes, progression to a substantive study could take place.
METHODS AND ANALYSIS: Fifty adult patients diagnosed with FND will be recruited. It will be a single-blind randomised controlled trial with two arms: EMDR (plus standard neuropsychiatric care; NPC) and standard NPC. The two groups will be compared at baseline (T0), 3 months (T1), 6 months (T2) and 9 months (T3). Measures of feasibility include safety, recruitment, retention, treatment adherence and acceptability. Clinical outcome measures will assess health-related functioning/quality of life, ratings of FND symptoms and severity, depression, anxiety, PTSD, dissociation, service utilisation and other costs. Improvement and satisfaction ratings will also be assessed. Feasibility outcomes will be summarised using descriptive statistics. Exploratory analyses using (linear/logistic) mixed-effect models will examine the rate of change in the groups' clinical outcome measures across the four time-points.After the intervention period, a sample of participants, and clinicians, will be invited to attend semistructured interviews. The interviews will be analysed using reflexive thematic analysis.
ETHICS AND DISSEMINATION: This study has been approved by the NHS West Midlands-Edgbaston Research Ethics Committee. Study findings will be published in open access peer-reviewed journals, presented at conferences, and communicated to participants and other relevant stakeholders. TRIAL REGISTRATION: NCT05455450 (www. CLINICALTRIALS: gov).

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Driessen, H. P. A., Morsink, S., & Busschbach…, J. (2023). Eye Movement Desensitization and Reprocessing (EMDR) Treatment in the Medical Setting: A Systematic Review. Available at SSRN …. https://doi.org/10.2139/ssrn.4495140

Open Access: http://dx.doi.org/10.2139/ssrn.4495140

Helen P.A. Driessen, PO Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail: h.driessen@erasmusmc.nl

Abstract

Background
This systematic literature review aims to evaluate the use and effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) therapy in adult patients treated in the medical setting.
Methods
We performed a systematic literature search of MEDLINE, Web of Science, PsycINFO, and the Cochrane Central Register of Controlled Trials, following the PRISMA guidelines. Studies were included if the effectiveness of EMDR was assessed in adult patients treated in a medical setting. Excluded were patients exclusively suffering from a mental health disorder, without somatic comorbidity. A risk of bias analysis was performed. This review was specified in advance and registered on PROSPERO (CRD42022325238).
Findings
89 studies are included and categorized in 14 medical domains: pain, oncology, neurology, obstetrics, otorhinolaryngology, rheumatology, cardiology, gynecology, dentistry, dermatology, pulmonary medicine, internal medicine, nephrology, and intensive care unit. In addition, three studies focusing on persistent physical complaints were included. Most frequently used outcomes were anxiety, depression, PTSD symptoms, and pain. These outcomes were assessed by study-specific and validated outcome measures. EMDR was found to be adequate in reducing symptoms in nearly all studies included (87/89). Only two studies, within the field of hospital gynecology, reported either no beneficial effects or that the beneficial effects did not remain over time. Notably, the occurrence of adverse events was rarely mentioned.
Interpretation
EMDR seems to have a beneficial effect on improving psychological and physical symptoms, including anxiety, PTSD, and pain, in adults treated in a medical setting. Most evidence exists for its application in the fields of oncology, pain, and neurology. The average treatment duration was relatively short, which further improves applicability in the medical setting

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Inci Izmir, S. B., Korkmazlar, Ü., & Ercan, E. S. (2023). Eye Movement Desensitization and Reprocessing Therapy in Adolescents With Panic Disorder: A Twelve-Week Follow-Up Study. Clin Child Psychol Psychiatry, 13591045231184757. https://doi.org/10.1177/13591045231184757

URL: https://pubmed.ncbi.nlm.nih.gov/37328192

Sevim Berrin Inci Izmir, Department of Clinical Psychology, Institute on Social Science, Isık University, Talatpasa Bulvarı Mustafa Bey ap. kat: 2 daire: 4, ̇Istanbul 34398, Turkey. E-mail: inciberrin@gmail.com

Abstract

The aim of this study is to investigate the effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) treatment in adolescents with panic disorder (PD). This follow-up study consists of 30 adolescents with PD without agoraphobia, aged 14-17 (15.53 ± .97). They were evaluated with Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children Present, also the Panic and Agoraphobia Scale (PAS) and Beck Anxiety Inventory (BAI) were administered at baseline, at the end of the 4th and 12th weeks of treatment. EMDR therapy which is an eight-phase treatment approach composed of standardized protocols and procedures was applied for 12 weeks, one session per week. The baseline mean of the total PAS score decreased from 40.06 to 13.13 at fourth week and 1.2 at the end of 12th week of treatment. In addition, BAI score decreased significantly from 33.67 to 13.83 at 4 weeks and 5.31 at the end of 12^th^ week of treatment. Overall, our results underscore the effectiveness of EMDR in adolescents with PD. Moreover, the current study suggests that EMDR may represent an effective intervention technique for PD in adolescents to protect against relapses and to overcome a fear of future attacks.

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Jauch, I., Kamm, J., Benn, L., Rettig, L., Friederich, H. C., Tesarz, J., Kuner, T., & Wieland, S. (2023). 2MDR, a Microcomputer-Controlled Visual Stimulation Device for Psychotherapy-Like Treatments of Mice. eNeuro, 10(6), ENEURO.0394-22.2023. https://doi.org/10.1523/ENEURO.0394-22.2023

Open Access: https://pubmed.ncbi.nlm.nih.gov/37268421

Sebastian Wieland, Department of Functional Neuroanatomy, Institute for Anatomy and Cell Biology, Heidelberg University, 69120 Heidelberg, Germany. E-mail: sebastian.wieland@med.uni-heidelberg.de

Abstract

Post-traumatic stress disorder and other mental disorders can be treated by an established psychotherapy called Eye Movement Desensitization and Reprocessing (EMDR). In EMDR, patients are confronted with traumatic memories while they are stimulated with alternating bilateral stimuli (ABS). How ABS affects the brain and whether ABS could be adapted to different patients or mental disorders is unknown. Interestingly, ABS reduced conditioned fear in mice. Yet, an approach to systematically test complex visual stimuli and compare respective differences in emotional processing based on semiautomated/automated behavioral analysis is lacking. We developed 2MDR (MultiModal Visual Stimulation to Desensitize Rodents), a novel, open-source, low-cost, customizable device that can be integrated in and transistor-transistor logic (TTL) controlled by commercial rodent behavioral setups. 2MDR allows the design and precise steering of multimodal visual stimuli in the head direction of freely moving mice. Optimized videography allows semiautomatic analysis of rodent behavior during visual stimulation. Detailed building, integration, and treatment instructions along with open-source software provide easy access for inexperienced users. Using 2MDR, we confirmed that EMDR-like ABS persistently improves fear extinction in mice and showed for the first time that ABS-mediated anxiolytic effects strongly depend on physical stimulus properties such as ABS brightness. 2MDR not only enables researchers to interfere with mouse behavior in an EMDR-like setting, but also demonstrates that visual stimuli can be used as a noninvasive brain stimulation to differentially alter emotional processing in mice.

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Mannarino, J. A., Carrico, A. W., Ean, N., Bruce, S., Vandermause, R., Kryah, R., Stein, E., Bertram, J., Shom, V., & Paul, R. H. (2023). Protocol for a randomized controlled trial in Cambodian individuals with PTSD: Trauma-Informed Treatment Algorithms for Advancing Novel Outcomes (Project TITAN). Contemp Clin Trials, 131, 107257. https://doi.org/10.1016/j.cct.2023.107257

URL: https://pubmed.ncbi.nlm.nih.gov/37271413

Julie A Mannarino, Missouri Institute of Mental Health, University of Missouri - St. Louis, St. Louis, MO, United States of America. E-mail: julie.mannarino@mimh.edu

Abstract

INTRODUCTION: Low- and middle-income countries shoulder a disproportionate burden of mental health disorders with limited resources to support the provision of care using culturally relevant, evidence-based interventions. This is particularly true in Cambodia where the population continues to confront traumatic consequences of the Khmer Rouge genocide that targeted educated people, including treatment providers. Trauma-Informed Treatment Algorithms for Advancing Novel Outcomes (Project TITAN) will examine proof of concept and preliminary efficacy of culturally tailored interventions for symptoms of post-traumatic stress (PTS) among Cambodian adults.
METHODS: A stepped care randomized controlled trial enrolling people seeking mental health treatment and priority populations with high rates of trauma exposure, including female entertainment and sex workers and sexual and gender minorities. In total, 160 participants with symptoms of PTS are randomized to Stabilization Techniques or Behavioral Activation plus Stabilization Techniques, implemented within a culturally relevant framework. Individuals who do not demonstrate a reduction in symptoms of PTS after six treatment sessions receive Eye Movement Desensitization and Reprocessing therapy. PTS, depression, anxiety, and substance use are assessed at baseline and two and four months post-randomization.
PLANNED ANALYSES: The percentage of individuals achieving reductions in symptoms of PTS after four months is the primary outcome. Secondary outcomes are depression, anxiety, and substance use over four months. Finally, machine learning analyses will be conducted to identify features at baseline and during treatment that predict outcomes.
DISCUSSION: Findings will guide future development and implementation of interventions to improve mental health conditions among individuals in Cambodia and other resource-limited settings.

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Reynoso-Sánchez, L. F., & Hoyos-Flores, J. R. (2023). A Single-Session Eye Movement Desensitization and Reprocessing (EMDR) Therapy Reduces Anxiety and Improves Self-confidence in Athletes with Post-traumatic Stress Associated with Injury. International Journal of Sport Studies for Health, 5(2). https://doi.org/10.5812/intjssh-134823

Open Access: http://dx.doi.org/10.5812/intjssh-134823

Luis Felipe Reynoso-Sánchez, Department of Social Sciences and Humanities, Autonomous University of Occident, Macario Gaxiola/Carretera Internacional, Los Mochis, Mexico. E-mail: felipe.reynoso@uadeo.mx

Abstract

Background: Stress and anxiety related to post-injury trauma in athletes is a latent problem in sport. The use of eye movement desensitization and reprocessing (EMDR) allows sports psychologists to intervene with their athletes more effectively to help them into their recovery and achieve peak sport performance.
Objectives: Analyze the EMDR therapy effect in the psychophysiological responses of four athletes with stress related to a traumatic event during sports practice.
Methods: Four athletes (22.25 ± 1.71 years; 11.5 ± 2.65 years of experience) participated an idiographic single-case, multiple-probe study. The Sport Psychology Department of the institution approved the study for its application, which also followed the statement of the declaration of Helsinki. The participants had been medically cleared to practice their sport after sustaining a severe injury, but they expressed significant difficulty in performing optimally yet. The Competitive State Anxiety Inventory-2RD was applied to measure the anxiety and self-confidence levels before, after and two weeks later EMDR therapy intervention. Eye movement desensitization and reprocessing standard protocol therapy was carried out to identify the dysfunctional memories to be reprocessed, address the abnormal behaviors as trauma consequences, and develop the behavioral changes to manage the trauma. Heart rate variability parameters used as biofeedback were monitored during the EMDR protocol to associate with moments of stress and relief. Data analysis was performed using the smallest worthwhile change (SWC) of Hopkins to compare the results in the different moments of the protocol and study.
Results: All four athletes reported likely and most likely beneficial changes (according to the SWC) in their levels of anxiety and self-confidence after the intervention with the EMRD therapy as well as at two weeks afterward. Heart rate variability (HRV) parameters linked with parasympathetic activity were reduced and the sympathetic parameters increased their levels when the intervention protocol induced stressor memories, observing an opposite behavior when EMDR phases let the athlete be relaxed or getting relief.
Conclusions: Eye movement desensitization and reprocessing is a therapy is effective to manage a sport injury related psychologic trauma. Furthermore both, LnRMSSD and LnSS parameters of the HRV can be used as a biofeedback strategy for a better efficacy of EMDR-based treatment.

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Rosen, G. M. (2023). Revisiting the Origins of EMDR. Journal of Contemporary Psychotherapy. https://doi.org/10.1007/s10879-023-09582-x

Open Access: http://dx.doi.org/10.1007/s10879-023-09582-x

Gerald M. Rosen, Department of Psychology, University of Washington, Seattle, WA, USA. E-mail: gmrseattle@gmail.com

Abstract

Francine Shapiro, the founder of Eye Movement Desensitization and Reprocessing (EMDR), reported that the therapeutic use of eye movement patterns was discovered by chance while walking in a park. An alternative accounting for the origins of EMDR comes from research that demonstrates individuals are unable to perceive their own eye movements and from historical sources that document Shapiro’s acceptance of Neuro-Linguistic Programming theory on eye movement patterns and super-achievers. The present paper brings together this diverse set of findings to provide a more accurate context within which Shapiro’s purported discoveries and subsequent claims can best be viewed.

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Van Es, C. M., Velu, M. E., Sleijpen, M., van der Aa, N., Boelen, P. A., & Mooren, T. (2023). Trauma-focused treatment for traumatic stress symptoms in unaccompanied refugee minors: a multiple baseline case series. Front Psychol, 14, 1125740. https://doi.org/10.3389/fpsyg.2023.1125740

Open Access: https://pubmed.ncbi.nlm.nih.gov/37325732

Carlijn Maria Van Es, Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands. E-mail: c.van.es@arq.org

Abstract

INTRODUCTION: Unaccompanied refugee minors (URMs) are at increased risk of developing mental health problems, such as symptoms of posttraumatic stress disorder (PTSD) and depression. In addition, URMs face several barriers to mental health care. Few studies have evaluated trauma-focused interventions for URMs that target these issues. The current study evaluated a multimodal trauma-focused treatment approach for URMs. It aimed to provide an initial indication of the effectiveness of this treatment approach and to provide a qualitative evaluation assessing treatment satisfaction of the participating URMs.
METHODS: A mixed-methods study was conducted among ten URMs, combining quantitative data with qualitative data through triangulation. Quantitative data were collected using a non-concurrent multiple baseline design in which repeated, weekly assessments were carried out during a randomized baseline period, during treatment, and during a 4-week follow-up period. Questionnaires assessing PTSD (Children's Revised Impact of Event Scale) and symptoms of depression (The Patient Health Questionnaire-9, modified for adolescents) were used. In addition, treatment satisfaction was measured post-treatment using a semi-structured interview.
RESULTS: During the qualitative evaluation, all but one URM noted they found the trauma-focused treatment approach useful and felt the treatment had positively impacted their wellbeing. However, the results of the quantitative evaluation did not show clinically reliable symptom reductions at posttest or follow-up. Implications for clinical practice and research are discussed.
DISCUSSION: The current study presents our search in developing a treatment approach for URMs. It adds to the current knowledge about methodological considerations in evaluating treatments for URMs, the potential effects of trauma-focused treatments on URMs, and the implementation of treatments for URMs.
Clinical trial registration: The study was registered in the Netherlands Trial Register (NL8519), 10 April 2020.

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Wetherell, S. (2022). Investigating the impact of eye movement desensitization and reprocessing (EMDR) in reducing birth trauma symptoms. Annals of Psychophysiology, 9(2), 67-75. https://doi.org/10.29052/2412-3188.v9.i2.2022.67-75

Open Access: http://dx.doi.org/10.29052/2412-3188.v9.i2.2022.67-75

Silvia Wetherell, Saybrook University, California, United States. E-mail: silvia@moremindful.me

Abstract

Background: Childbirth-related traumatic experiences are an overlooked area of psychological suffering, often leading to Post-Traumatic Stress Disorder, Perinatal Mood and Anxiety Disorders, and difficulties in bonding between mother and baby. This study aimed to evaluate the effectiveness of Eye Movement Desensitization and Reprocessing as a brief psychological intervention in reducing Birth Trauma symptoms.
Methodology: Using a prospective experimental longitudinal design, 12 women residing in Singapore with Birth Trauma symptoms received three 90-minute eye-movement and desensitization (EMDR) sessions over two weeks on average. Participants were assessed through two trauma self-report questionnaires and underwent a brief Autonomic Nervous System (ANS) assessment.
Results: Post-treatment assessment showed significant differences in mean trauma scores with a 76% reduction on the Modified Perinatal PTSD Questionnaire (z = -3.061, p = .002) and 70% reduction on the Impact of Event Scale Revised (z = -3.061, p = 0.002). Skin conductance response changes from baseline to stressor reduced by 4% but were not statistically significant (z = -.863, p = 0.39).
Conclusion: Brief EMDR has shown promise as an effective treatment for Birth Trauma. Larger controlled randomized studies are required to evaluate the effectiveness of EMDR when compared to a placebo control group.

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